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AVITA PHARMACY 1073
RWI78212 BEAT AIDS COALITION TRUST
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Covered Entity Details
Entity Name
BEAT AIDS COALITION TRUST
Subdivision Name
Type
Ryan White Part A
340B ID
RWI78212
Entity Address
208 W EUCLID AVE
SAN ANTONIO, TX 78212
Grant Number
H89HA31891
Participating Start Date
1/1/2017
Last Recertification Date
2/15/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1073
Pharmacy Address
AVITA DRUGS LLC DBA AVITA PHARMACY 1073
300 SOUTH 2ND STREET
SUIT 102
MCALLEN, TX 78501
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHELE DURHAM, EXECUTIVE DIRECTOR
(210) 212-2266 Ext: 102
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/12/2022
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